Liver transplantation as a multidisciplinary strategy for undergraduate education

O programa de transplante de fígado presta-se, no dia a dia, de forma excelente, ao ensino de graduação, especialmente na forma de iniciação científica com trabalhos de investigação experimental em laboratórios ou na forma de monitoria formal em investigação experimental ou clínica. Nesta segunda modalidade, o aluno auxilia o professor orientador em atividades mais ligadas à enfermaria e centro cirúrgico, com trabalhos de acompanhamento clínico dos doentes, ou estudos de casos em investigações tanto prospectivas como retrospectivas. Cabe ao orientador, atribuir atividades balanceadas, cujos horários de execução não colidam com os formais da graduação. Da mesma forma, cabe ao aluno estruturar suas horas livres para dedicar parte delas ao exercício da atividade científica. Assim, o aluno de graduação, terá a oportunidade de vivenciar as mais variadas facetas do transplante, tendo dele a necessária visão sistêmica, à medida que seu conhecimento se amplia. A importância do transplante é exatamente esta, com o contato diário, ao longo do tempo, formar a idéia plena do todo a partir das complexas partes que o constituem, propiciando ao graduando participar de situações e discussões que não são freqüentemente abordadas durante a graduação.The program of liver transplantation can contribute in an excellent manner to undergraduate education on a daily basis, especially in the form of scientific initiation with studies of experimental investigation in the laboratory or as formal monitoring in experimental or clinical investigation. In the latter modality, the student helps his tutoring professor in activities more related to the ward and to the Surgical Center, with studies on the clinical follow-up of patients, or with case studies in both prospective and retrospective investigations. It is the task of the adviser to attribute balanced activities whose time of execution will not interfere with formal graduation hours. Similarly, it is the responsibility of the student to structure his free time in order to devote part of it to the exercise of scientific activity. On this basis, the medical student will have the opportunity to experience the most varied facets of transplantation, acquiring the necessary systemic view of the procedure as his knowledge expands. The importance of liver transplant is exactly this, i.e., to obtain a complete idea of the whole with daily contact along time starting from the complex parts that constitute the procedure, exposes the student to diverse clinical situations rarely encountered together in other specialties, permitting him to participate in situations and discussions that are not often addressed during the medical course

Management of bone metastases in renal cell carcinoma: bone-targeted treatments, systemic therapies, and radiotherapy

Metastatic renal cell carcinoma (mRCC) presents with bone metastases in around 20%-30% of patients enrolled in the most recent first-line clinical trials. Emergence of several new agents in first line, in both monotherapy and combination, has significantly improved patient outcomes. However, the activity of such agents on bone metastases is unclear and management of these patients is complex, due to potential complications that can significantly impair quality of life. This review addresses mRCC diagnosis and monitoring and summarizes the current evidence on systemic therapy, ablative therapies such as stereotactic ablative radiotherapy and surgery, and supportive therapy with bone-targeting agents for these patients, with the goal of improving their outcomes

Comparing Prognosis for <i>BRCA1</i>, <i>BRCA2</i>, and Non-BRCA Breast Cancer

Background: Germline pathogenic variants (PV) in BRCA1 and BRCA2 genes, which account for 20% of familial breast cancer (BC) cases, are highly penetrant and are associated with Hereditary Breast/Ovarian Cancer Syndrome. Previous studies, mostly including higher numbers of BRCA1 BC patients, yielded conflicting results regarding BRCA1/2 BC outcomes. In the Portuguese population, BRCA2 BC is diagnosed more frequently than BRCA1 BC. We aimed to compare clinicopathological characteristics and prognosis between BC patients with BRCA1 and BRCA2 mutations and a control group without germline PV (BRCA-wt). Furthermore, we explored the frequency and outcomes of risk-reducing surgeries in BRCA-mutated patients. Methods: Prospective follow-up was proposed for patients with a diagnosed BRCA1/2 PV. For this study, a matched control group (by age at diagnosis, by decade, and by stage at diagnosis) included BC patients without germline PV. We compared overall survival (OS) and invasive disease-free survival (iDFS) within the three groups, and the use of risk-reducing surgeries among the BRCA cohort. Results: For a mean follow-up time of 113.0 months, BRCA-wt patients showed longer time to recurrence (p = 0.002) and longer OS (p BRCA mutations, no statistical differences were found, although patients with BRCA2 BC had longer iDFS and OS. Uptake of risk-reducing surgeries (contralateral prophylactic mastectomy and salpingo-oophorectomy) were negative predictors of invasive disease and death, respectively. Conclusions: Testing positive for a BRCA PV is associated with a higher risk of relapse and death in patients with BC in the Portuguese population. Risk-reducing mastectomy and salpingo-oophorectomy were associated with lower incidence of relapse and longer median iDFS and OS, respectively